New Study Shows Half of Children With Autism Can Be Accurately Diagnosed at Close to One Year of Age

BALTIMORE, July 3 /PRNewswire-USNewswire/ -- In a study published today
in the Archives of General Psychiatry, researchers from the Kennedy Krieger
Institute in Baltimore, Maryland found that autism can be diagnosed at
close to one year of age, which is the earliest the disorder has ever been
diagnosed. The study, which evaluated social and communication development
in autism spectrum disorders (ASD) from 14 to 36 months of age, revealed
that approximately half of all children with autism can be diagnosed around
the first birthday. The remaining half will be diagnosed later, and their
development may unfold very differently than children whose ASD is
diagnosable around the first birthday. Early diagnosis of the disorder
allows for early intervention, which can make a major difference in helping
children with autism reach their full potential.
Researchers examined social and communication development in infants at
high and low risk for ASD starting at 14 months of age and ending at 30 or
36 months (a small minority of the children exited the study at 30 months).
Half of the children with a final diagnosis of ASD made at 30 or 36 months
of age had been diagnosed with the disorder at 14 months, and the other
half were diagnosed after 14 months. Through repeated observation and the
use of standardized tests of development, researchers identified, for the
first time, disruptions in social, communication and play development that
were indicative of ASD in 14-month olds. Multiple signs indicating these
developmental disruptions appear simultaneously in children with the
disorder.
Dr. Rebecca Landa, lead study author and director of Kennedy Krieger's
Center for Autism and Related Disorders, and her colleagues identified the
following signs of developmental disruptions for which parents and
pediatricians should be watching:
-- Abnormalities in initiating communication with others: Rather than
requesting help to open a jar of bubbles through gestures and
vocalizations paired with eye contact, a child with ASD may struggle to
open it themselves or fuss, often without looking at the nearby person.
-- Compromised ability to initiate and respond to opportunities to share
experiences with others: Children with ASD infrequently monitor other
people's focus of attention. Therefore, a child with ASD will miss
cues that are important for shared engagement with others, and miss
opportunities for learning as well as for initiating communication
about a shared topic of interest. For example, if a parent looks at a
stuffed animal across the room, the child with ASD often does not
follow the gaze and also look at the stuffed animal. Nor does this
child often initiate communication with others. In contrast, children
with typical development would observe the parent's shift in gaze, look
at the same object, and share in an exchange with the parent about the
object of mutual focus. During engagement, children have many
prolonged opportunities to learn new words and new ways to play with
toys while having an emotionally satisfying experience with their
parent.
-- Irregularities when playing with toys: Instead of using a toy as it is
meant to be used, such as picking up a toy fork and pretending to eat
with it, children with ASD may repeatedly pick the fork up and drop it
down, tap it on the table, or perform another unusual act with the toy.
-- Significantly reduced variety of sounds, words and gestures used
to communicate: Compared to typically developing children, children
with ASD have a much smaller inventory of sounds, words and gestures
that they use to communicate with others.
"For a toddler with autism, only a limited set of circumstances -- like
when they see a favorite toy, or when they are tossed in the air -- will
lead to fleeting social engagement," said Landa. "The fact that we can
identify this at such a young age is extremely exciting, because it gives
us an opportunity to diagnose children with ASD very early on when
intervention may have a great impact on development."
The current study reveals that autism often involves a progression,
with the disorder claiming or presenting itself between 14 and 24 months of
age. Some children with only mild delays at 14 months of age could go on to
be diagnosed with ASD. Landa and her colleagues observed distinct
differences in the developmental paths, or trajectories, of children with
early versus later diagnosis of ASD. While some children developed very
slowly and displayed social and communication abnormalities associated with
ASD at 14 months of age, others showed only mild delays with a gradual
onset of autism symptoms, culminating in the diagnosis of ASD by 36 months.
If parents suspect something is wrong with their child's development,
or that their child is losing skills during their first few years of life,
they should talk to their pediatrician or another developmental expert.
This and other autism studies suggest that the "wait and see" method, which
is often recommended to concerned parents, could lead to missed
opportunities for early intervention during this time period.
"What's most exciting about these important advancements in autism
diagnosis is that ongoing intervention research leads us to believe it is
most effective and least costly when provided to younger children," said
Dr. Gary Goldstein, President and CEO of the Kennedy Krieger Institute.
"When a child goes undiagnosed until five or six years old, there is a
tremendous loss of potential for intervention that can make a marked
difference in that child's outcome."
While there are currently no standardized, published criteria for
diagnosing children with autism at or around one year of age, Landa's goal
is to develop these criteria based on this and other autism studies
currently underway at the Kennedy Krieger Institute. Landa and her
colleagues at the Institute plan on releasing preliminary diagnostic
criteria for very young children with autism in an upcoming report.
Participants in the current study included infants at high risk for ASD
(siblings of children with autism, n=107) and low risk for ASD (no family
history of autism, n=18). Standardized tests of development and play-based
assessment tools were used to evaluate social interaction, communication
and play behaviors in both groups at 14, 18 and 24 months of age.
Researchers assigned diagnostic impressions at every age, indicating
whether there were clinically significant signs of delay or impairment.
After their last evaluation at 30 or 36 months, each participant was then
given a final diagnostic classification of ASD, non-ASD impairment, or no
impairment. The ASD group was further divided into an Early ASD diagnosis
group and a Later ASD diagnosis group based on whether they were given a
diagnosis of ASD at 14 or 24 months.
About Autism
Autism spectrum disorders (ASD) is the nation's fastest growing
developmental disorder, with current incidence rates estimated at 1 in 150
children. This year more children will be diagnosed with autism than AIDS,
diabetes and cancer combined, yet profound gaps remain in our understanding
of both the causes and cures of the disorder. Continued research and
education about developmental disruptions in individuals with ASD is
crucial, as early detection and intervention can lead to improved outcomes
in individuals with ASD.
About the Kennedy Krieger Institute
Internationally recognized for improving the lives of children and
adolescents with disorders and injuries of the brain and spinal cord, the
Kennedy Krieger Institute in Baltimore, MD serves more than 13,000
individuals each year through inpatient and outpatient clinics, home and
community services and school-based programs. Kennedy Krieger provides a
wide range of services for children with developmental concerns mild to
severe, and is home to a team of investigators who are contributing to the
understanding of how disorders develop while pioneering new interventions
and earlier diagnosis. For more information on Kennedy Krieger Institute,
visit http://www.kennedykrieger.org.